<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" data-rule="required" class="form-control" name="row[name]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Code')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-code" data-rule="required" class="form-control" name="row[code]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('License')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-license" data-rule="required" class="form-control" name="row[license]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address" class="form-control" name="row[address]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Other')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-other" class="form-control " rows="5" name="row[other]" cols="50">NULL</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">法人姓名:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-leader_name" class="form-control" name="row[leader_name]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">法人电话:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-leader_phone" class="form-control" name="row[leader_phone]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">法人邮箱:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-leader_email" class="form-control" name="row[leader_email]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Service_agent_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-service_agent_id" data-rule="required" data-source="service/agent/index" class="form-control selectpage" name="row[service_agent_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">手机号:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone" class="form-control" name="row[phone]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Password')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-password" class="form-control" name="row[password]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Openid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-openid" class="form-control" name="row[openid]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Unionid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-unionid" class="form-control" name="row[unionid]" type="text" value="">
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
